Provider Demographics
NPI:1821195751
Name:MEDI-SERVICE OF CHARLOTTE INC
Entity Type:Organization
Organization Name:MEDI-SERVICE OF CHARLOTTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-516-2121
Mailing Address - Street 1:610 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5702
Mailing Address - Country:US
Mailing Address - Phone:704-289-1523
Mailing Address - Fax:704-289-4758
Practice Address - Street 1:610 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5702
Practice Address - Country:US
Practice Address - Phone:704-289-1523
Practice Address - Fax:855-841-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC113783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137361OtherPK
SC000068587Medicaid
NC0905257Medicaid
SC000068587Medicaid